BHCHP Policy: Prescribing of Nasal Naloxone Rescue Kits to Reverse Opioid Overdose
Effective: Jan 1 2013
1.0 Purpose & Scope
1.1 Purpose:
The purpose of this policy is to describe procedures for the outpatient prescribing of Nasal
Naloxone Rescue Kits to reverse opioid overdose in patients at risk for opioid overdose.
Recent data suggest opioid overdose as a common cause of mortality in BHCHP patients.
Massachusetts legislation now allows for the prescribing of naloxone for use in the
outpatient setting.
1.2 Scope:
This policy covers instructions for prescribers, pharmacy & patients.
2.0 Definitions
2.1 Overdose
- Throughout this document use of term overdose refers exclusively to opioid overdose
2.2 Nasal Naloxone Rescue Kit:
A kit prepared by the pharmacy containing the following components:
- Two Naloxone 1mg/ml pre-filled syringe
- Two Nasal atomizer devices
- Instruction sheet for patients
o See attached: “Nasal Naloxone Instruction Sheet for Patients”
3.0 Attachments / Related Documents
- “Nasal Naloxone Instruction Sheet for Patients”
- “Nasal Naloxone Rescue Kit Experience Survey”
- “Nasal Naloxone Rescue Kit Assembly” Video
“Rescue Breathing” Instructional Video
4.0 Roles & Responsibilities
4.1 P&T Committee:
- Responsible for maintenance of this policy
4.2 Prescriber:
- Prescriber is responsible for selecting appropriate patients:
o Required emergency care involving opioid intoxication or overdose
o Suspected history of substance abuse or nonmedical opioid use
o Patients with active opioid prescription or illicit opioid use
o Patients receiving methadone or buprenorphine treatment
o
-
At the request of patient or caregiver or discretion of healthcare provider
Prescriber or agent is responsible to educate patient about overdose prevention & use
of nasal naloxone
Sending prescription to BMH pharmacy
NOTE: At this time, most outside pharmacies cannot dispense Nasal Naloxone Rescue
Kits
4.3 Pharmacy:
- Pharmacy will be responsible for the preparation & dispensing of Nasal Naloxone
Rescue Kits
- A staff pharmacist will be responsible for counseling patient on how to assemble & use
the device
4.4 Patient:
- Patient will be responsible for picking up medication at BMH pharmacy and receiving
counseling on how to assemble and use the kit.
- It will be the responsibility of the patient to request refills of the kit.
4.5 Other clinic staff
- Clinical staff / case managers will be responsible for being aware of the availability of
nasal naloxone & referring patients who express interest or have risk factors for opioid
overdose to the appropriate clinical staff
5.0 Procedures
5.1 Prescriber:
- Prescriber will send a prescription to BMH pharmacy for Nasal Naloxone Rescue Kit as
follows:
o Naloxone 1mg/ml Prefilled Syringe Qty: 2 RF: 2
If overdose suspected, CALL 911 first. Attach nasal device, spray half the
contents into each nostril; repeat after 3 minutes if no response.
-
Prescriber or agent should educate patients about the risks of opioid-related overdose,
how to reduce overdose risk and the importance of seeking help by calling 911 in the
setting of a suspected overdose.
o At minimum, patient should be counseled on how to recognize an overdose,
how to assemble & how to use the kit.
o Whenever possible, additional training should include the following videos
posted on the BHCHP intranet: BPHC Nasal Naloxone Video & Rescue
Breathing Instruction
o Documentation of patient education must be documented in patient chart.
5.2 Pharmacy:
- Pharmacy will dispense kits pursuant to receiving prescriptions from BHCHP staff
- Pharmacist / Pharmacy Intern will counsel patient when they pick up their prescription
from the pharmacy
5.3 Patient:
- Patients will report to BMH pharmacy during normal business hours (M-F 8a-5p) to pick
up their kit.
- Patients requesting a refill will be responsible for filling out a short, anonymous
questionnaire about their experience with the kit
o See attachment: “Naloxone Experience Patient Questionnaire”
6.0 References
Baggett TP, Hwang SW, O’Connell JJ, et al. Mortality Among Homeless Adults in Boston: Shifts in
Causes of Death Over a 15-Year Period. JAMA Intern Med. 2013;():1-7.
doi:10.1001/jamainternmed.2013.1604.
Loimer, N., P. Hofmann, and H.R. Chaudhry, Nasal administration of naloxone is as effective as
the intravenous route in opiate addicts. Int J Addict, 1994. 29(6): p. 819-27.
Act Relative to Sentencing & Improving Law Enforcement Tools. S. 11. 187th MA Cong, (2012)
“Naloxone or other opioid antagonist may lawfully be prescribed and dispensed to a
person at risk of experiencing an opiate-related overdose or a family member, friend or
other person in a position to assist a person at risk of experiencing an opiate-related
overdose. For purposes of this chapter and chapter 112, any such prescription shall be
regarded as being issued for a legitimate medical purpose in the usual course of
professional practice.”